CALIFORNIA
In juvenile hall, a struggle over STD testing
High rates of sexually transmitted diseases among incarcerated youth reflect a broader problem
Incarcerated youth in San Francisco usually come from high-crime, economically depressed neighborhoods, and bring with them the health issues associated with poverty and poor access to medical care.
Case in point: during the past two months, teenage boys at Youth Guidance Center (YGC), San Francisco’s juvenile hall, have tested positive for chlamydia at about five times the rate of California’s general population. The numbers aren’t surprising to San Francisco health outreach workers – but getting support for testing and treatment of sexually transmitted diseases among such teens has been anything but easy.
Deb Levine, executive director and founder of Internet Sexuality Information Services, Inc. (ISIS), has been instrumental in bringing health services to some of the city’s most elusive youth populations. ISIS received a two-year outreach grant in 2008 to engage underserved youth in sexual health services and education using web and mobile technology. The focus was on getting young, hard-to-reach African American and Latino men, in neighborhoods such as Hunter’s Point and Visitacion Valley, screened for chlamydia and gonorrhea. “They have so many conflicting problems in their lives,” she says. “If you talk to them about chlamydia, it’s not a priority. Their priorities are jobs, food, safety. It’s the poverty and economic cycle they’re stuck in.”
Levine’s work was coming along, but a year into the project, SFDPH, which had partnered with ISIS, had to make a tough call. Facing two years worth of budget cuts, totaling $1.2 million, the department’s STD section stopped screening the vast majority of men (even teenage boys) for common STDs in public clinics citywide. The move was expected to save SFDPH almost $60,000 over the last year, but public school health educators and community outreach workers were outraged to learn that they could no longer send asymptomatic kids to get screened. Levine says her initial thoughts when she heard about the new guidelines are unprintable. “Truly, I was horrified, she says. “I’m the mother of two girls. As a parent I was worried about the health of young people.”
At the time, the new regulations, based on national Centers for Disease Control (CDC) guidelines, seemed medically sound. Young women test positive for STDs at higher rates than young men and face more STD-related health problems down the line, such as pelvic inflammatory disease and infertility, so why not allocate the bulk of available resources for them? But the guidelines failed to address the fact that most young women are infected by young men, who are less likely to practice monogamy than their female sex partners. “The idea that you only treat young women is erroneous,” Levine says, adding that young men aren’t always the most dependable stewards of sexual responsibility. “If a girl says, ‘Hey honey, I have chlamydia, you’d better go to the clinic,’ the boyfriend might say, ‘I’m just going to get a new girlfriend.’”
Shortly after SFDPH stopped screening young men, ISIS held a public event in the Bayview to teach youth about the risks of chlamydia and gonorrhea. A mobile testing van was onsite, but because it was meant to serve San Francisco residents, the new guidelines applied and young men were not tested. Levine’s outreach workers were in the bizarre position of speaking to youth about the importance of getting screened while denying that service to their target demographic. “We had to change our message from, ‘Get tested, get screened,’ to, ‘Take care of your sexual health,’” she says. “But without a cultural change, that doesn’t mean anything. Young people say, ‘What is sexual health?’”
Levine went back to her funders and requested a second grant, this one to support the screening of males age 12-24 for chlamydia and gonorrhea for one year. ISIS received the grant and several public clinics started testing young men again this past April. Since May 1, 170 teenage boys have been screened at YGC. Five tested positive (2.9%). That might sound like a small number, but Michael Baxter, Director of Community Health Programs for Youth, says it’s significant. The chlamydia rate across the board in California is 407 positive tests per 100,000 people (less than .5%). For now, all youth coming into juvenile hall are tested for STDs and Baxter says the high rate at YGC justifies the reinstated screening mandate. “When I see two or three percent, I say, ‘okay, we’re doing the right thing,’” he says.
Baxter, whose program provides health services to youth at YGC, believes the decision to stop screening young males last year may have contributed to the recent numbers. “Yes, it had an impact,” he says. “They (young men) were spreading it and we weren’t screening them.”
Now, outreach workers have less than a year to engage as much of that population as they can. The city’s cultural geography tells a story. Skyrocketing STD rates among young, low-income minorities aren’t merely a measure of sexual behavior; they’re a telling gauge of our determination to address the wellness of kids in all San Francisco communities, and our willingness to allocate resources on a triage basis. Distribution of wealth isn’t really about money—it’s about access and education.
Trey Bundy
14 July 2010
http://www.baycitizen.org/columns/file-under-juvenile/juvenile-hall-struggle-over-std-testing/
